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227 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 beneficial to those patients. It would be in the same category as this. People and doctors, if they knew they had to labor over every patient until physiologically they had total collapse of the patient, and unless there had been an advance directive we would have a lot more advance directives. I have a sense that if researchers believe that their IRB's will not allow them to do research of a certain category unless they have discussed that category of research with the subject in advance at a time when the subject can make a choice, and as you and Bernie have pointed out this is much more applicable to people who go in and out of periods than to someone who is on a course because the person who goes in and out has some sense of what you are talking about. The person with Alzheimer's -- it is a harder prospect to know. But the incentive will be there to have those conversations and to have that sorting. Now once you get a person who is in the category that they, themselves, have said it is all right it is not as though you have carte blanche with them of course. But the understanding is that no research institution will allow the research to go on at a greater minimal risk of no potential benefit on those people for
228 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 whom that -- I prefer to think of it as prospective consent instead of an advance directive. Prospective consent and appointment of their surrogate. They have not gone through that process or they went through it and they said no, they were not interested, or whatever reason. If you do not have that from them they are out. They are protected in a sense that they will not be subjected to that except by someone who is willing to break the law. DR. CASSELL: I want to see examples of the advance -- I mean, the advance consent, which I think is a good distinction. DR. CHILDRESS: I am sorry, Eric. I missed that. DR. CASSELL: I would like to see copies of what you mean. I mean, you can write a general, very general statement of somebody approves the research, they really would like to be a member of a research project even if they cannot consent at that time, very general statement and then I understand what the person is doing but the more concrete you get the less valuable the thing is and the more broad it becomes the more question there is are they really consenting to the -- MR. CAPRON: And the key thing that you are
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whom that -- I prefer to th<strong>in</strong>k of it as prospective consent<br />
<strong>in</strong>stead of an advance directive. Prospective consent and<br />
appo<strong>in</strong>tment of their surrogate.<br />
They have not gone through that process or they<br />
went through it and they said no, they were not <strong>in</strong>terested,<br />
or whatever reason. If you do not have that from them they<br />
are out. They are protected <strong>in</strong> a sense that they will not<br />
be subjected to that except by someone who is will<strong>in</strong>g to<br />
break the law.<br />
DR. CASSELL: I want to see examples of the<br />
advance -- I mean, the advance consent, which I th<strong>in</strong>k is a<br />
good dist<strong>in</strong>ction.<br />
DR. CHILDRESS: I am sorry, Eric. I missed<br />
that.<br />
DR. CASSELL: I would like to see copies of<br />
what you mean. I mean, you can write a general, very<br />
general statement of somebody approves the research, they<br />
really would like to be a member of a research project even<br />
if they cannot consent at that time, very general statement<br />
and then I understand what the person is do<strong>in</strong>g but the more<br />
concrete you get the less valuable the th<strong>in</strong>g is and the<br />
more broad it becomes the more question there is are they<br />
really consent<strong>in</strong>g to the --<br />
MR. CAPRON: And the key th<strong>in</strong>g that you are